Monthly Musings…

A Newsletter from the Internal Medicine Residency Director

“The complicated, ambiguous milieu of human contact is being replaced with simple, scalable equations. We maintain thousands more friends than any human being in history, but at the cost of complexity and depth. Every minute spent online is a minute of face-to-face time lost.”  Daniel H. Wilson

“Nothing replaces being in the same room, face-to-face, breathing the same air and reading and feeling each other’s micro-expressions.”  Peter Guber

“The difference between face-to-face conversation and any other medium of communication is simple: No distractions are permitted.”  Alexandra Petri

“Digital communication is completely different from in-person, face-to-face conversations. One will give you surface insights, and the other really gives you depth.” Joe Gebbia

“Social media websites are no longer performing an envisaged function of creating a positive communication link among friends, family and professionals. It is a veritable battleground, where insults fly from the human quiver, damaging lives, destroying self-esteem and a person’s sense of self-worth.”  Anthony Carmona

My kids are adults now and, mostly, out of the house now.  So we are trying to reclaim some space and get rid of junk that they have collected over the last 21 years.  We are a reading family, and have collected an extensive library of PAPER books (not Kindle!), including books I would be embarrassed to say I read once.   Anyways, enough about me – I ran across my son’s college freshman required reading introductory book and found it to be a very interesting and appropro read.  The book’s title is “Reclaiming Conversation” by Sherry Turkle.  As you may suspect, it is a commentary on the changes of how we communicate in this era of social media and the digital platform.  I haven’t completed it yet – (I stopped when I reached the chapter on romance), but there are several observations noted by the author that I found illuminating.  I am going to reflect on the lessons I learned from the book through my own lens– from my experiences working as a Program Director, and my experiences in practicing medicine.

The opening chapter grabs you fairly quickly – educators are noting now that middle school kids, don’t make eye contact, and they don’t respond to body language, mostly because they are looking at their phones.  Even in the playground, teachers have noted kids don’t seem interested in each other.  In one instance, one child excluded only ONE classmate out of 25 from a celebration, and had NO concept of the hurt and potential damage that they caused.  There is a sense from educators that kids are losing their sense of empathy, and have a lot of trouble reading emotions in their peers.  In another part of the book a study showed a 40% decline in empathy among college students (don’t ask me the scale or how they defined it…).

The second set of notable stories that the book talked about pertains to education, and how we may or may not absorb information in a way that is retained.  How many of you are “google-jockeys”?  In the middle of someone lecturing or doing a talk you hear something and either disagree with it or want clarification so get on your smart phone and start looking it up?  According to one college student the author interviewed, conversation died in 2009, but so did boredom.  If you aren’t particularly compelled by what is happening at that moment, you have the WORLD, or your friends (I will get to “friends” in a moment), at your disposal to explore right on your phone. Even in a small meeting where there are only 3 to 4 people, how many of you have your phone out ON THE TABLE (evidence shows face up or face down doesn’t matter), announcing, or hoping, that there might be someone more important than those in the room that needs to talk to you (or more, you wish would interrupt the meeting so you can leave)?!

So back to the first part.  The loss of empathy is concerning, especially as some of these “kids” are going to grow up to be doctors.  More and more we live in a world of acquaintances rather than deep friendship.  To truly know someone takes hard work, difficult and long (dare I say “boring”?) face-to-face conversations.  Human relationships are rich, messy and demanding.  The book gives one example of a person who tried to console their friend, in person, who had recently been fired.  The friend instead spent time on the phone checking out how many “likes” she got on her social post about her firing, and the pithy statements that her 200 “friends” sent her.  How many of you wish you could just tell someone they had cancer, then walk away and let them post it so they could “chat” with their “friends” over it. By how I phrased that you all certainly realize how deeply disconcerting and WRONG that is. Sherry Turkle notes that a physician and author, Abraham Verghese, has written about how medicine has moved away from treating the patient to treating the “iPatient” – the sum of the data we have collected about a person, rather than talking to the patient. Mr. Verghese argues that when we lose the empathic connection with the human being in their care, we lose the ability to cure.  One last story, this one recently from NEJM 360.  One resident noted that the most significant thing they learned from their attending one day during rounds was, after the resident presented a patient who came in with chest pain while walking their dog, the attending asked, “What was the name of the dog?”

Now for the second part. As a profession, we are probably the most dopamine addicted people in the world.  We feel the need to multi-task, and don’t (or do we argue “can’t”?) live a life with boring parts.  We have our pagers, and our cell phones out, because we TRULY believe that there is someone more important out there than the person in front of you right now.  In many ways we are right – there are code 54’s, code blues, and rapid responses that need our immediate attention. But there is a certain arrogance to that, and we can then carry through that logic to then assume that the dopamine surge from Dr. A is more important than Dr. B, who is more important than Dr. Consultant, who is more important than nurse D, who is definitely more important than academic half day (which has many “boring parts” after all), and, in the end, is still more important than patient Z, who wants someone to talk to them just asking for some clarity on their care….

Life will have boring bits – in work, love, and friendship, but what might be boring to you is of interest to someone else.  So what is my ask?  I am going to ask that we all work through the boring parts together.  I am as guilty as the majority – I try to multi-task and do one thing while trying to listen to you present a case and look at my phone.  (Let’s be honest, that dopamine surge is hard to resist…) Let’s develop our emotional intelligence, put down the phone for a bit, look, and listen to each other, and our patients, as we tell our stories.  It takes real intentionality.  When I converse “correctly”, I often actually say to myself, just before the conversation starts, “Stop doing what you are doing, look at the person and pay attention!”  What can we get out of doing this?  Well, first and foremost, the lack of focused attention now is so pervasive that we ALL forget that, at the end of the day, not paying attention to someone talking to you is JUST PLAIN RUDE (and I am as guilty as everyone else..).  On the positive side, the experience of boredom is directly linked to creativity and innovation.  If we remain curious about our boredom, we can use it as a moment to step back and make a new and real connection.  And, when I have focused attention, some of my best ideas come from really listening in at a long meeting.

There is some irony in the fact that I am sending this musing about the loss of conversation via an EMAIL.  This musing has been deeply edited and reviewed multiple times by me to ensure that there is no overly inflammatory commentary.  Yes, face-to-face talk is difficult and messy as I noted, so the edited self seems so much better.   The way social media presents a “perfect” version of yourself, one that you yourself edited, and one that is impossible to live up to, is a discussion for another day.

I don’t want to digress too far from medical education and our own experiences, but one last comment.  The anonymity of social media has so divided this country with people, especially politically, on opposite sides who will only listen to the blurbs that come out from their side.  Too often, neither side will enter into the deep conversation and conciliation that is needed to heal this country.  Because to do so takes HARD WORK. There will be boring parts, and there will be the smart phone with the next blurb, and the next ”like” out there, and so we start the work, then get distracted…  But I have hope that we as physicians will be successful in reconnecting.  Residency by its very nature is made up of physicians who work exceptionally hard – I mean, whoever heard of a business that says it is OKAY to work EIGHTY HOURS/week?  ‘Nuff said….

ANNOUNCEMENTS

KUDOS – Just want to give a quick congratulations to Ricky, who got third place for his research poster, and Chari, who received 2nd place for her QI poster, at the recent ACP RESIDENT AND STUDENT’S DAY on October 10th.  I also want to congratulate everyone again who had posters there as well as Babak for his oral vignette.  I mirror Ayham’s thanks to all of you who volunteered at the meeting.  It was wonderful to see such great participation.  And I want to thank Ayham for all his hard work that day!  Interesting end to the Doctor’s Dilemma – Ayham and I can tell you the story if interested…

TUESDAY NOVEMBER 6th – WELLNESS OUTING. VOTE!!!  Brooklyn Builders outing.  100 S Morgan St. in Chicago.  All residents on elective need to be there no later than 2pm.  Admin will be there by 1:30 at the latest to set up and arrange things. All IMS regular teams should be done and be there close to 2pm.  I will advise the attendings to assist you and get you out and to take calls and do orders and the work after 12noon.  ICU members who can get out would be great.  I don’t expect NF there unless you want.  We are still trying to find a happy hour place – around 4pm.  Might just make it Lou Malnati’s again, like last year.  SO’s invited to all parts of the afternoon. NO need to pay for now.

HOSPITAL OWNERSHIP TRANSITION – Switch in ownership has been delayed – it is still going through but getting 3 hospitals exchanged is hard.  In the meantime, as soon as we know, we will let you know about signing up for benefits (trust me – I need insurance for my whole family – I will let you know AS SOON AS I KNOW).   Also, I will send a separate email about our outpatient EMR, but Athena is also going to transition, and it will be messy.  We are going to lose our platform, and it will be “read only”.  More to come, and we will work through it.

RESEARCH PROJECTS – RESEARCH DAY TUESDAY NOVEMBER 27TH.  This is only ONE MONTH AWAY.  Second years, I have not signed ANY forms to get IRB approval for your projects.  Please contact your research advisor, or to Ayham, for help.  We will discuss the consequences if this is NOT complete.

RECRUITMENT IS ONGOING – We have already had two recruitment days – THANK YOU!  Please do your best at being good hosts – introduce yourselves to the applicants, sit among them and talk with them, and continue to actively participate in Medical Chopped. Make sure you have all checked when it is your turn to sit with them in the morning and take applicants on tours.  If you are free at that time also come by and talk to the applicants. Remember, applicants eat first.  We will get more food – but last recruitment day we ordered for FORTY people, and we ran out…Be mindful of waste please.

COMMUNITY OUTREACH – If I have time, I will try to find ways to promote some outreach projects as winter approaches…

Enjoy the pictures from ACP Resident’s day

Take care everybody….

SSY

Scott S Yen MD FACP
Program Director
Internal Medicine Residency Program
West Suburban Medical Center
[email protected]
(O) 708 763 2256

“Quality is not an act, it is a habit.”  Aristotle

“Be a yardstick of quality.  Some people aren’t used to an environment where excellence is expected.”  Steve Jobs

“Quality is never an accident. It is always the result of intelligent effort.”  John Ruskin

“Quality means doing it right when no one is looking.”  Henry Ford

“Error is pervasive.  The unexpected is pervasive…What is not pervasive are well-developed skills to detect and contain these errors at their early stages.”  Karl E Weick

“An incident is just the tip of the iceberg, a sign of a much larger problem below the surface.”  Don Brown

I know this newsletter is pretty late, but this is a difficult (read “uncomfortable”) subject to write (talk) about…and it deserves a measured strong voice….

In July 2017, the ACGME (the governing body of residency programs) required that ALL residency programs begin complying with Common Program Requirement VI, which is a descriptor of what the ACGME expects us to have in a residency program’s “Learning and Working Environment”.  It’s thrilling reading, let me tell you (19 pages of single space type…).  Anyways, there are FIVE parts to it – the latter FOUR parts (B-F) has received the most publicity and has been praised in the media and from all medical societies – that the ACGME has mandated that residency programs promote wellness, provide a professional collegial environment (i.e. don’t “dump” on the residents), provide fatigue mitigation, promote resiliency and prevent burnout in residents (this section also describes in detail supervision and duty hours).  Definitely important.  NO question about it.  Medicine and residency is HARD.  It is relentless and time consuming and scary at times.  It is our responsibility (this is the all-encompassing “we” – so includes the hospital, leadership, faculty, AND residents) to work together to find ways to take safe, quality care of our patients, learn medicine to become an excellent physician, be professional, and learn to balance this all without burning out and losing our love of this profession.

What I think we have lost sight of a little bit is the FIRST part of this requirement (Part A – which suggests that this is the “more” important component). Part VI A’s TITLE is “Patient Safety, Quality Improvement, Supervision and Accountability.”

Here is the opening summary statement of this section:

“All physicians share responsibility for promoting patient safety and enhancing quality of patient care. Graduate medical education must prepare residents to provide the highest level of clinical care with continuous focus on the safety, individual needs, and humanity of their patients. It is the right of each patient to be cared for by residents who are appropriately supervised; possess the requisite knowledge, skills, and abilities; understand the limits of their knowledge and experience; and seek assistance as required to provide optimal patient care.

Residents must demonstrate the ability to analyze the care they provide, understand their roles within health care teams, and play an active role in system improvement processes. Graduating residents will apply these skills to critique their future unsupervised practice and effect quality improvement measures.

It is necessary for residents and faculty members to consistently work in a well-coordinated manner with other health care professionals to achieve organizational patient safety goals.”

The section goes on to explain CORE requirements that our program and residents must do, within this context.  These include participating in QI projects, including QI within your own panel of patients, promoting a culture of safety, activating error systems, doing root cause analyses.

So why am I talking about this component of your medical education?  I think most of you are worried (groaning?)/thinking that I am now going to get on your cases about; procrastinating on your QI projects, or not showing up to hospital committee meetings, or not putting reports in the Midas system, or not contributing at our biweekly M and M.  NOPE!  (okay maybe a little…)  I am here to APOLOGIZE on behalf of leadership – we have probably not been able to provide the oversight nor the metrics to “properly” educate you on this topic.  We haven’t provided you with the details on how you practice medicine so that you can make changes to your panel of patients (inpatient and outpatient).   I ask myself if all of us have been promoting a real strong culture of safety and quality (with the exception of Dr. Marinelli who is truly our performance distinction champion).  For us, and for you, this is probably THE single most difficult component of your residency education.  This section is a new component of medical education, and you have probably not been adequately exposed to this in medical school.  You have probably not been taught in medical school how to promote safety, other than on an individual basis (ie. working to be safe one patient at a time), nor learned how to do a QI project.  These things are out of your comfort zone, and also a bit out of our comfort zone.

What’s the “best” way to solve this conundrum and “gap” in your education?  How do we all become better at this part of your education?  I think the absolute EASIEST AND HARDEST way to solve this is to END the culture of silence. (Though I promise – we will do more than just this – we will find our quality and safety champions.)

In medicine, more than almost any other profession, we have a culture of silence.  We have all grown up with this idea that “OMERTA” is cool.  In medicine, this comes at a very high cost – for patients – medical errors, morbidity and mortality.  For doctors – the cost is suicide, depression, burnout.  We need to do better.  And I get it – it is VERY uncomfortable.  We don’t want to speak in front of a panel of people explaining yourself and your actions, so we also hope to protect our fellow doctor, or nurse from having to do the same, and don’t say anything. We are human – we make mistakes.  Systems are not infallible, they are made by humans, mistakes can occur. We LEARN from mistakes so we don’t do it again.  We fix systems, so that error doesn’t happen again.   We ALL have to be better, and that absolutely includes me.  At the most recent buzz session, I want to give a quick thanks to those who spoke up about a potential ED throughput problem, and not getting calls about patients for several hours.  But get us the MRN’s.  JUST this Wednesday morning, at the Medical Executive Committee meeting, ATTENDINGS BROUGHT UP THE SAME PROBLEM.  Same issue – no one wrote down MRN’s, no one spoke up at the time of delay.  When we collect the data, Dr. Anthony will look, and help figure it out – is it a system issue? Is it a case by case basis?  Is it one attending in the ED that is an issue?  Changes can only occur IF WE SPEAK UP and write it down.  (FYI – and yes, you spoke up – so once all of you have worked on a template for the progress note that will satisfy faculty and your fellow residents, we can go back to typed progress notes.)

Here is an example of a problem that the residents brought up first, and now there is going to be a change. We switched to a new tele-psychiatry company last winter.  After the first month, some residents came to me to discuss problems with the system and how it works, which I brought up to administration.  Later, there was some improvement. Then, in the spring, there were more complaints from residents, about the setup, and lack of timely follow through. This too was brought to administration. This year, more complaints, some from residents, which again administration was made aware of.  We have all had enough.  We are changing tele-psychiatry companies.  Of course, it took time, but change happened.  Thanks to you.

The ACGME are made up of smart people, and they are often prescient about the future of medicine.  I think there is another reason that they have made quality and safety a program requirement.  We are at a critical juncture in medicine.  With a huge physician shortage, more and more physician assistants and APN’s are given the responsibility to care for patients.  Minute clinics manned by APN’s, hospitalist APN’s, APN anesthesiologists, PA’s in physician offices now often do the work of taking care of patients, and they don’t cost insurers or patients as much money.  Anyone with some medical education can follow a protocol – “chest pain protocol, ACS protocol, pneumonia protocol, sepsis protocol.  But the ability to notice the variations, to find the flaws in the protocols, recognizing the patterns when problems occur – THAT is what makes the difference between a doctor and an allied health professional.  This is what patients want to see their doctors do.  That is what makes doctors leaders in patient care.  My wife likes to say – do you want to be a line cook, or do you want to be chef?  Something to contemplate…

ANNOUNCEMENTS

KUDOS – Just want to give a quick congratulations to the IM residents and the ICU team for completing the first month in our ICU.  Lots of busy days, interspersed with some lighter days, but always full attention.

ACP RESIDENT AND MEDICAL STUDENT’S DAY –

Wednesday October 10th.  Coming next week!  Congratulations again to all who had their posters/e-posters/oral vignette accepted to compete for prizes and potentially a trip to the national ACP meeting in Philadelphia in Spring 2019.  Make sure you have put an attending’s name on the poster. Make sure you have the template for the poster format. Remember that you will need to have your poster on a hard board. This year to save money the ACP has purchased easels (trust me it seems “cheap” but the old way costs $3000/year for one hour of work). There will be hard boards available for purchase there for those looking to travel by public transportation or who feel strongly they will win and go on to the national meeting…

As well, we are one of the hosts of the event this year. That means we will be running the Doctor’s Dilemma competition – so we will be there all day.  ALL HANDS ON DECK!. We need everyone who is free to come help out. There are all sorts of ways to help out – see Ayham for details.

SPEAKING OF RESEARCH PROJECTS –

We have a research forum end of November!  That is only TWO MONTHS AWAY.  Second years, I have not signed any forms to get IRB approval for your projects.  Please contact your research advisor, or to Ayham, for help.  See above to understand how important I feel this is for you to get done.

RECRUITMENT COMING! –

Hard to believe that we are starting interview season again.  Didn’t this most recent class of hard working interns just start?  I can’t even begin to explain the large role that all of you play in bringing in the next class of residents.  Ayham has already sent a memo to some of you who have been assigned to participate in the first set of interviews at the end of this month.  We will give a mini-orientation at one of the academic half-days this month to describe everyone’s role during interview day, even if you have not been specifically assigned to participate.

COMMUNITY OUTREACH –

I have enclosed a few pictures of community fundraisers that my wife and I have attended in recent weeks. My wife and I did the Heart walk on September 22, in Oak Brook.  You may have seen many of the bake sales and other fundraising efforts in the lobby for many weeks.  West Suburban did a great job raising funds for the American Heart Association.  The other picture is of a roast of my son’s old wrestling coach, raising money for Beat the Streets Chicago.  Many of you know that my wife was the Executive Director for the Oak Park River Forest Chamber of Commerce, supporting small businesses.  Well, she is moving on, and will now be the Executive Director for Beat the Streets Chicago, which is looking to help inner city youth get off the streets and into a safe environment – for wrestling, for tutoring, for learning.  I know that the Housestaff has a committee looking at doing more community outreach.  It is getting colder, I am hoping we can start hearing about some projects to help those in need.

Take care everybody….

SSY

Scott S Yen MD FACP
Program Director
Internal Medicine Residency Program
West Suburban Medical Center
[email protected]
(O) 708 763 2256

“It is easy to make stuff up – and easy to dig up information and repeat it or report it to others. But to find a real life story with real people in real life situations is quite difficult and time-consuming. Yet, the rewards are worth the effort.”  Lee Gutkind

“I like to listen. I have learned a great deal from listening carefully. Most people never listen.” Ernest Hemingway 

“Listen to your patient, he is telling you the diagnosis.” Sir William Osler

“Tell me the facts and I’ll learn. Tell me the truth and I’ll believe. But tell me a story and it will live in the heart forever.” – Native American Proverb

“Stories are memory aids, instruction manuals and moral compasses.” – Aleks Krotoski, The Guardian

“You have to understand that the shortest distance between a human being and truth is a story.” – Anthony de Mello

I think I saved my friend’s life this past weekend…

I will get to safety and quality in medicine another day – life sometimes brings a different reflection…

My wife and son and two of our best friends, a married couple, were at a restaurant enjoying a wonderful meal last Friday when my friend left for the bathroom.  He was in there an unexpectedly long time, and when he came back he leaned heavily on our dining table, and said in a raspy whisper “I don’t feel well we need to go.”  He was blue in the lips, pale and plethoric.  I yelled out to him to ask what was the matter, but he didn’t respond and stumbled, spilling the wine on the table and knocking some chairs over.  I grabbed him and looked up to my wife, who took the words right out of my mouth and said “I am calling 911.”  Another restaurant patron assisted me in getting my friend to a chair, but he remained staring into space, unresponsive.  I couldn’t get a pulse, so we got him to the floor.  He started gurgling, and making grunting noises, and continued to stare, it seemed in abject terror, up and to the left.  He wasn’t breathing otherwise, and I still couldn’t get a pulse, nor could the Good Samaritan next to me.  Those of you who have been first responders, especially out in the community, will understand the dawning realization I had that told me “oh, f…., I need to do something NOW.”  So, I said a small prayer, and started CPR.  I heard some cracking of cartilage, which I took as a good sign that I was getting proper compressions (thanks Tony and see picture below), did a set of 30, and then stepped back…and by fortune, he was breathing.  His pulse was also strong now and in the 70’s.  There was a tense several minutes as he started blinking and looking around, then coughing and gagging a little, while EMS had yet to arrive.  A side, now funny, note.  As I was over him monitoring him, a guy dressed in a coat and tie who had come from a rehearsal dinner party in the room next to the main dining floor, barges in – actually pushes me aside, looks at me balefully, doesn’t identify himself, and immediately feels for a pulse on my friend’s neck.  At that point EMS arrived and took over, and I was able to tell EMS the story above.  (We figure the guy was probably a surgeon…)

We went to the nearest emergency room (not here FYI) where we waited to hear news about my friend.  We were eventually allowed to go into the room to visit him.  His color was back, and he was better but weak.  He was nauseated and dizzy, and still a little dazed, so he and his wife told me to sit tight as they had told the ED doc that they weren’t sure what happened and they should probably talk to me.  We waited, then a CXR and a chest CT was done, and then we waited some more. Then the ED doc came back.  The doctor was nice, they stated that the CXR and CT chest angiogram was okay, they weren’t sure what happened, he didn’t have a heart attack, that all his labs were normal except his potassium was 2.8 and they were going to replete it, they weren’t sure why his potassium was so low, but that might have set off an arrhythmia, but he may have also had a vasovagal response, or this was all just severe dizziness so we gave you some meclizine. They also, appropriately wanted to keep him overnight. Then the doctor LEFT.  My friends had me nearby, and as soon as the ED doc was gone they turned to me and asked – “so in laymen’s terms, what did the doc just say?” So another hour passes and my friend gets to the floor and the nurse settles him in.  She asks what medicines he is on – he mentions he is on losartan HCTZ.  After the nurse left, I decided to ask my friend what he did that day – he had mowed the lawn, walked the dogs, and worked in the yard a lot of the day.  Did he drink much water?  In retrospect about 2 glasses, but not much else, and also hadn’t eaten much all day.  Was this the first time anyone asked you about this? YES.  Did anyone ask you about your meds? NO.

My friend is fine – he is home and resting, though they had the extra trauma of having to put their dog of 17 years down this weekend as well.  We are still not entirely sure what happened, though based on my story I think we can all guess at what likely happened.  He will go for further testing soon and maybe I can report what was found.  At the end of the day he received EXCELLENT care, and I am thankful to EMS, the hospital and the very friendly staff that did everything that needed to be done to be sure he was okay and safe.  (Okay I have to give one comment from my administrative hat – they kept him an extra day unnecessarily because no one read the tests done on Saturday morning, no hospitalist pushed to get results back or came back on Saturday afternoon to talk to him or his wife, so he sat until Sunday.) Even his ribs aren’t that sore, so maybe I didn’t press hard enough…

At the end of the day I tell you the story of the scary event to draw you in, but I think it is obvious, from the above quotes, and from what I wrote, of the lesson, or reflection, that I want you to think about this month.  Every patient has a story that is just WAITING to be heard, that can help clarify and give answers to the differential diagnosis that goes on in our heads as we review the patient data.  Sometimes, (though I admit it would be rare indeed) a knowledgeable physician who happened to be on the scene could help provide some of that story – they just need to be asked.  AND, most of you know this, IT TAKES WORK AND TIME to get the story.  I know, it is sometimes just a lot easier to just get all the data, depend on the ER history, and figure it out from there.  But sometimes the story is the memorable part, and helps us remember better the individual, the person that we took care of, and not the numbers, or the disease process.  Do you better remember the “78 year old NH patient with dementia and ulcers coming in with AMS and with an overbearing family…”  or the “78 y/o AAF who was the first female Illinois Supreme Court justice who unfortunately has dementia and ulcers coming in for AMS.  Family is worried and is struggling with the balance of being aggressive to know what is going on vs. comfort care…”  Which is more memorable?  Which presentation is more positive?  Which story probably took longer to get?
This was a reminder to me this past weekend that for all we push to learn about data, about numbers, about throughput and discharges, about processes, etc. that there is a human being with a story, and they can inform us about the life they live, and the choices they have made that have led them to become, for likely a brief time, a part of yours or our life experience.

ANNOUNCEMENTS

KUDOS – Can I just say WOW!  We had TWELVE abstracts accepted for ACP Resident’s day!  Once we have compiled the whole list of winners we will send it out.  This is probably a record number accepted from our residency – strikingly impressive!  Along with Babak’s oral presentation, we will have prominent representation at this event this year, taking place Wednesday, October 10th.  Because we will be in the ICU, I cannot close services for this event this year, but everyone who is competing in the live poster competition (we have students AND residents competing in both research and clinical vignette categories) will be able to go.  Ayham will have quite a challenge for scheduling, but we will figure it out.  CONGRATULATIONS!  Great Job!

CONGRATULATIONS! To Eric Chung, who is getting married next week.  Studies show a happier and longer life when married…so cheers!

ICU – HERE WE COME!  We got a little bit of a break this year and have not been in the ICU for the last 5 months.  I am hoping that was a nice break for all of you, but now we will be back taking care of the critically ill.  I hope that our participation in the Simulation lab that we just had will be helpful to prep you for some procedures as well as code protocols.  Ayham sent you some videos on ICU care, and we had a nice presentation by some seniors at the last Academic half-day on working in the ICU.  Best of luck to all of you.

RECRUITMENT IS COMING!  We start reviewing applications on September 15th, and interviews will start end of October.  If any of you know students who might be interested in coming to West Sub for either a preliminary or categorical position next year let me know, I will take a look at their application.  We have a change this year in that we will be busy in the ICU during much of interview season, so we will be moving more interview dates into December and January, when we are out of the ICU.  We will send out the interview dates next month.  Thank you to all who have helped bring in this excellent class that we have this year!  We will have a brief talk on resident responsibilities and how to present our program during recruitment season at one of the Academic half-days prior to interviews starting (Ayham I promise the talk will be brief)!).  Be ready again for Medical Chopped!

CONCORDIA UNIVERSITY STUDENT CLINIC RESUMING THIS MONTH.  For those of you new to our residency, we oversee the walk-in student clinic at Concordia University in River Forest, Illinois, which is the city just west of Oak Park.  This is an opportunity to care for a different population of patients than we see in our AIM continuity clinic.  We are there every Monday, Wednesday and Thursday afternoon from 1 – 4:30pm (or 1:30 – 5 – TBD) while school is in session.  It is always interesting to note how little school there really is, especially once you start really working….  Be prepared to give allergy shots, do PPD testing, and deal with acute illnesses, and musculoskeletal complaints in a younger generally healthy population.  Last year, we dealt with some unique diseases, including acute Lyme disease, and Marfan’s.  I will send more information to those specifically going regarding parking, location, etc.  Good luck!

ROSS STUDENT EXPERIENCE ENDS.  Thanks to all faculty and residents who have helped educate the Ross University medical students all these years. We have matched with some wonderful residents who did their track here.  We will continue to have Loyola students come for a third year experience in IM, so continue to put on your professor hats and give your time to them.  With the administration’s permission, we are seeking a relationship with another medical school (currently talking with three schools), but that won’t happen for a bit.

EVALUATIONS – Help improve our residency program, be honest in your opinions, give some written feedback, or come to Ayham, Dr. Yedavalli or I to discuss issues.  We can’t make changes without real feedback.  Just as a start, from honest feedback, we are looking to create more structure in teaching rounds. More to come…

For those of you who have the weekend off – enjoy.  Best of luck to those starting a new service tomorrow, esp. the ICU. Take care everybody….

SSY

Scott S Yen MD, FACP
Program Director
Internal Medicine Residency Program
West Suburban Medical Center
[email protected]
(O) 708 763 2256 

Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.”  – Measure for Measure, Shakespeare

“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” – Mother Teresa

“We must become bigger than we have been: more courageous, greater in spirit, larger in outlook.  We must become members of a new race, overcoming petty prejudice, owing our ultimate allegiance not to nations but to our fellow men within the human community.”- Haile Selassie

“If by a “Liberal” they mean someone who looks ahead and not behind, someone who welcomes new ideas without rigid reactions, someone who cares about the welfare of the people-their health, their housing, their schools, their jobs, their civil rights and their civil liberties-someone who believes we can break through the stalemate and suspicions that grip us in our policies abroad, if that is what they mean by a “Liberal”, then I’m proud to say I’m a “Liberal.”    – John F. Kennedy

“Oak Park is crazy – it’s like a social experiment”

“Instead of being six feet deep that boy is six feet tall with the will to be a Harvard graduate color accurate black panther doctor of neuroscience innovator
They know we are not thugs or high school dropout or target practice
We are monarch majesties pyramid building slave plantation-taking, Million man marching Rulers of the Country.”  A spoken word rap from a student in “America to Me” a documentary on Oak Park River Forest High School coming to Starz starting August 26, 2018.

A whole lot of everything has happened in the very first month of this academic calendar year (well, our hospital was sold to a new owner, for one…), and I have numerous times thought about changing my topic this month.  Also hence the lateness.  I have decided to stick to what I wanted to talk about originally, so here goes….

When I was 3 ½ months old, my father moved our family to Huntsville, Alabama, to work as an aeronautical engineer for NASA for the Apollo projects.  It was an amazing and, as it turns out, a historic opportunity as my father helped put men on the moon.  As you are probably deducing, yes, we were one of very few Asian families deep in the South in the 1960’s-70’s, so few, in fact, that I don’t remember a single child my age that was like me.  Additionally, I was a sickly kid, suffering from allergies, and often sick.  In school gym, I vividly remember being made to swim along the side wall, as I was the only one who couldn’t make it across the pool without having to stop and rest.  I was also painfully shy, especially with girls, so that, if a girl even looked at me, I would start to blush, and sometimes even ran away. Yet I NEVER experienced any prejudices or bullying while I was there, as far as I recall (in retrospect, I had a friend and, probably, a protector – a boy named Andrew who was two grades above me, who probably made sure that nothing happened to me).  Huntsville, despite its deep South roots, was a progressive community that seemed to understand that the economics of the town depended on engineers of all shapes and colors and sizes to work in the town together to win the space race against, at that time, the Soviet Union.  Progressive to the point that, when the Apollo projects ended, and we moved back to California, that a small contingent of Asian families stayed to raise their kids in Huntsville, Alabama.

Which, of course, brings me to the communities of Oak Park and Chicago-Austin.  I think one should always learn a little bit about the communities you work and/or live in to understand and get a flavor of the type of people you will be working with, and caring for, and taking care of, and learning from, and doing outreach for.  There are entire books out there (including a book cover picture I have included at the bottom of this musing) that talk about Oak Park and the surrounding neighborhoods, particularly the Austin community, but I want to limit (okay not really but I figure I have 10 minutes of your time….) this musing to a few paragraphs. So I want to bring you my perspective having lived here for 24 years.

Oak Park, like Huntsville, is a progressive town.  Perhaps the desire to preserve its own roots, yet, with its location right across the street from urban sprawl, necessitated that the denizens of Oak Park have this liberal attitude. (I should probably read a book on Oak Park…)  Hence Oak Park is a mix of dichotomies, or mixed messages.  Oak Park is a phenomenally wealthy town – home of Frank Lloyd Wright multi-million dollar homes, but highly desirous to help with fair housing…as long as that fair housing is not in their neighborhood which lowers their property value.  We love the independent business and their green nature, but they need to have convenient parking and have prices equal to the big box stores.  Oak Park desperately wants to help the Austin neighborhood become better, but is rightly concerned with crime, and sets up barriers along Austin.  Oak Park – a little hypocritical at times, but enthusiastic to help and do good, sometimes misguided in direction, but always earnest and heartfelt.

My wife Cathy probably said it best in her TedX talk a year ago about the Oak Park bubble (I have alluded to this talk in the past).  If interested have a listen.

https://www.youtube.com/watch?v=i9dABmhwypM

Austin community, where 60% (70%?) of our patients at WSMC come from, is, to put it mildly, a community in need.  Rotary International, a philanthropic club that I talked about last newsletter, yearly looks around the WORLD for communities in dire need of funds, scholarship, infrastructure, etc.  This past year, because they have been so successful in helping around the world, including being so close to its goal of ending polio, they have looked in the US for communities in need.  Austin community is one of those communities considered in high need.  Yet still there are pockets in Austin with nice houses, friendly neighbors, and wonderful people.  My daughter, growing up, had a great friend that lived in the Austin community (knew her through dancing at the Chicago Multicultural Dance Center).  I was always afraid for my wife and daughter as she was driven to birthday parties, etc. in the Austin community, but felt safe once they arrived.

So here you sit, at West Suburban Medical Center, here in wealthy, liberal Oak Park, but running alongside a community that is considered one of the neediest IN THE WORLD.  How does one understand this dichotomy?  Here is my plug to encourage all of you to watch “America to Me” coming to Starz, a documentary about our local high school (filmed by Steven James, who also made the critically acclaimed documentary “Hoop Dreams”).  The film crew spent an academic year following 12 Oak Park River Forest high school students, predominantly African-American students, as they navigated life in a racially integrated wealthy suburb, and how they survived, failed, or thrived in this community.  Our family was very close to two of the featured kids (both wrestlers) so, on a personal level, I am excited to see if my son (filmed during his senior year) and my wife will get some air time.  But why I encourage you all to watch it is this – much of the documentary talks about closing the achievement gap – so you will get a chance to see Oak Park adults being earnest, heartfelt, liberal, maybe misguided, in trying to help the African American student – perhaps a reflection of trying to help the Austin Community.  And you will see the African American perspective, who objectively needs help but maybe doesn’t always want help.  (The documentary has not aired yet and I am not privy to the final cut, but I think it will be compelling theater).

Lastly, I want to comment a little bit about the sale of our hospital.  I want to laud our current administration, particularly Joe Ottolino, and BJ Krech, and Stasia Thompson, and Marta Alvarado, with working with Tenet Healthcare and pushing to become a bigger part of the Oak Park community.  They have become sponsors in many philanthropic endeavors.  Now, the new investors from TWG group, have Chicago ties, and public health ties.  I have already reached out to Eric Whitaker (he was my medical school classmate and has been integrally involved in public health and community service for many years), and talked to him about our community minded hospital and my desire to want to talk about making more inroads in helping the Austin community.  Just taking care of our patients in the hospital and sending them back into the same environment that they came from doesn’t lead to long term success and change in the community.  I am looking forward to the relationship with our new owners.

 

ANNOUNCEMENTS

CONGRATULATIONS!  First, I want to mirror Ayham’s recent acclamation in his Chief’s update, and congratulate our first-year residents on getting through the first month, hopefully still excited to learn – from faculty, from each other, and, foremost, from our patients…

LOYOLA UNIVERSITY SIMULATION LAB –1pm – 5pm Friday August 17th, followed by HAPPY HOUR 5:30-7:30pm at Trattoria 225.  Be ready!  We will close all services all afternoon so everyone can attend.  For the Thursday night Night Float team, you will be excused around midnight.  For Friday night, the NF team will be expected to start around 8pm.  For the IMS teams, you will finish up your work and be excused after 12noon.  The on-call team should probably pick up the last admission of the day at around 10am to give you time to finish to get to Loyola University.  The Simulation lab is at the Loyola medical campus in Maywood – about a 20-minute drive from the hospital.  We start at 1pm sharp, so get there early if you can.  This is an opportunity to practice procedures, do some ACLS and Rapid Response simulations, and overall start feeling more comfortable with this part of your training.

AFTER the simulation lab, we will have happy hour at Trattoria 225 on 225 Harrison Street in Oak Park Illinois.  We will have plenty of food for all of you.  ALL FACULTY ARE INVITED AS WELL.

ACP ITE – Just another heads up.  Friday August 24th and Friday August 31st.  This is for categorical residents only.  This is much like a Board’s practice exam.  I would hope that third years take this test seriously (not necessarily to study for it, but to concentrate as if it was the actual Boards), as it is your opportunity to practice taking a day-long test.  We will close AIM clinic on August 31 so that group will take the test on that day.  The rest we will try to limit interference as much as possible with work and schedule accordingly.

GOOD LUCK TO ALL THE SENIOR RESIDENTS TAKING THE IM BOARDS THIS AUGUST.  Wish them a hearty good luck!

We will be heading into the ICU next month.  Ayham will be sending out a link to videos, some from the ACP as a privilege with being an elite status program., on ICU topics to help you prepare.

Next month, I am going to focus on Common Program Requirement VI…sounds stultifyingly boring – but stay tuned…

Take care everybody….SSY

Scott S Yen MD FACP
Program Director
Internal Medicine Residency Program
West Suburban Medical Center
[email protected]
(O) 708 763 2256

“The need for connection and community is primal, as fundamental as the need for air, water and food.”  Dean Ornish

“Everyone desires relationships and community.  Most people want to belong to a cohesive, like-minded group.  It staves off loneliness.  It promotes identity.  These are natural and very human instincts.”  Joshua Ferris

I want to give a hearty welcome to the new internal medicine (and FM too) residents to West Suburban Medical Center!  To those new to my musings, this newsletter is my chance to reflect on this whole “educating the next generation of internists” thing.  I find this experience immeasurably fascinating, frustrating, fun, and fulfilling (any other “f”s you can think of?), and this format gives me the chance to reflect on this through the written word.  This newsletter is meant to be informational, inspirational, thoughtful, helpful, or, a complete waste of time…

As I mentioned at the White Coat ceremony (and thank you again to Dr. Scott Levin and the FM program for going first while I raced back from the airport), I was just in Toronto accompanying my wife as she attended the Rotary International conference.  I was utterly impressed with the easy diversity and unassuming ease at which the eclectic population of Toronto intermingled and existed together.  Two examples.  We were eating at a nice restaurant, where our extra attentive waiter felt compelled and comfortable inviting us to the Gay Pride parade the next day.  Another day, we ate at an old Italian restaurant, with communal tables, where young and old, Bohemian and Preppy, and every race sat together and enjoyed the fantastic food.

But as eclectic as the city of Toronto is, I was also struck by how groups still want to have an identity tag, to say that they belong, or are a part of, another, more close knit family.  One family was Rotary.  I think when many of you think of Rotary, you think of rich older suburbanites (I certainly did once).  Instead, I have found that Rotary is a world-wide organization, with members coming from every part of the world, dedicated to ending poverty, and disease (the organization’s biggest goal is almost complete – ending polio) by being innovative and creative and putting in the hard work.  You would be amazed at how proudly they wear their Rotary bling!  They love wearing their light blue and yellow shirts, scarves, vests, hats, etc., and fill their lapels with pins with the Rotary logo.

The other very large family was the LGBTQIA+ family.  The largest Pride parade in North America was filled with the colors of the rainbow.  No matter the color of your skin (and there was lots of that showing too), or your gender (or neutral), all the colors sparkled during the parade.  A completely different group than the one I was with at the Convention center, but the same sense of belonging occurred with wearing the colors of the rainbow.

So where am I going with this?  We are an eclectic group of doctors coming from all over the country and from different parts of the world.  We are each our own individual person who will bring a unique brand of you to this institution.  But we all also share a mutual interest which I hope brings you all closer, and makes you feel comfortable becoming part of the West Suburban family.  I want each of you to feel like you belong here, however temporarily.  We too have our “bling” (we plan to order your fleece soon – sounds distasteful in this current hot weather but is plenty nice in the fall/winter).  We share a common goal – taking care of the patients in our community as best we can.  You have already seen this family come together just this Friday, when a fire broke out in the North hospital floors, requiring evacuation of patients from the area.  I know some of you were among those who aided in the evacuation, as I had just left the floors (holed up in the basement with the door closed after the Code Red I didn’t hear the ongoing announcements), and I am proud of the fact that you all stepped up to help.

Over the years I have been bemused, “thought it was cheesy”, (and probably more than that) by the “rah rah” that occurs over sports teams, over schools, etc.  As an introvert, I felt like I was above that. But I have come to realize that part of being human is wanting to be part of a tribe, and I am very proud to say WSMC is my tribe.  I am hoping that, even after you graduate, we will make this place feel like a place you can belong, and that you will always be welcome here.  As we go through this next academic year’s journey together, let me know how I can make you feel like part of the family.

ANNOUNCEMENTS

ACADEMIC HALF DAY.   Starting this Tuesday, July 3, and every Tuesday hereafter, we will work hard to bring you an academic curriculum that will be fun, interactive, and educational.  Be participatory in this endeavor, and as time goes on, bring us your ideas and we will work to incorporate them into the half day (my idea – monthly radiology rounds?).  Of note, any month that there are FIVE Tuesdays, the fifth Tuesday will be a “mini-retreat”.  Okay, no escape rooms, but happy hour, bowling (again?), scavenger hunt, architecture tour, rock climbing?. Anyone?

ACP RESIDENT’S DAY and oral vignette/poster submissions.  Please work hard on getting poster submission to ACP Resident’s day by July 11, 2018.  For those who don’t know, West Suburban’s IM residency program will be one of three hospitals hosting the event this year, which will be on Wednesday, October 10, 2018.  So let’s represent!  As IM will be in the ICU in October, I will be unable to close the IM services fully this year for everyone to attend, but will do my best to get most of us there.  Of course, if you are chosen to do the oral vignette, or get your poster chosen to present, you will get to go (hint hint).

LOYOLA SIMULATION LAB – Friday August 17th.  We will close service so everyone can attend.  This is an opportunity to practice procedures, do some ACLS and Rapid Response simulations, and overall start feeling more comfortable with this part of your training.

ACP ITE – Friday August 24th and Friday August 31st.  This is for categorical residents only.  This is much like a Board’s practice exam.  I would hope that third years take this test seriously (not necessarily to study for it, but to concentrate as if it was the actual Boards), as it is your opportunity to practice taking a day-long test.  We will close AIM clinic on one of the Fridays so that group will take the test on that day.  The rest we will try to limit interference as much as possible with work and schedule accordingly.

Take care everybody…  SSY

Scott S Yen MD FACP
Program Director
Internal Medicine Residency Program
West Suburban Medical Center
[email protected]
(O) 708 763 2256